Wednesday, August 11, 2010

Who Ya Gonna Call?

After Clyde and I broke it off and I told all my doctors our relationship had ended, I continued getting my Bonnie Numbers four times a day and faxed them to the endocrinologist weekly. My numbers have been lovely and steady, thank you body. So far, so good.
And then the poo hit the fan. Last week my endocrinologist's nurse asked that I get a hemoglobinA1C blood test. This is a simple test that looks at red blood cells and gets the average glucose percentage in your body for the past 3 months. Anything between 4.9 and 6.0 is normal. Mine was 5.1 several months ago; totally normal. But she wanted me to take another to get an update. Rule-follower that I am, I didn't ask questions. I took my veins down to the local blood suckers, who actually know me AND Abe by first name now, and left a little sample.
This week, the nurse called back and left me a message.
"Hi Erin. This is Dr. Endo's nurse. She said your hemoglobin A1C went up and she wants you to up your dosage of insulin starting this week. Call me back, thanks, bye."

Several things wrong with this message:
1. Will I ever talk to the endocrinologist again, or just the nurse?
2. She never mentioned what my A1C percentage was now? I'll be completely panicking about that until I get back in touch with her.
3. I'm not taking insulin anymore, and I told her that 2 weeks ago. How do I up the dosage if I'm not taking any?

I called her back and she told me my A1C was 5.6, and then immediately had to run and "would call me back to answer more questions." Now, I'm not sure how good you are with numbers, but to me, 5.6 still appears to fall within the "normal range." I mean, double check my math...but...
So instead of calmly determining my next questions before the nurse called back, I started crying and getting very angry.
Irrational, party of 1? Your table is ready.

My husband was out of town and I didn't know any friends who would understand why I was so angry and felt in my BONES she was going to tell me I had no choice but to go back on insulin despite my awesome Bonnie Numbers and normal A1C and how FRUSTRATING THAT WAS!

And then a little song began to play in my head.
"When a doctor's nuts, and you need some guts, who ya gonna call?
When they don't make sense, you need good defense. Who ya gonna call?

I rattled off the whole story to Doula and she agreed, it didn't quite make sense yet. She helped me formulate my questions (Why are you recommending insulin? Is 5.1 to 5.6 a big jump? Is there lab variability? Do my Bonnie Numbers mean nothing?) and armed me with a little pep talk about trusting my instincts. And when that nurse called back, I was ready. An informed patient, I offered up my questions and encouraged her that I was glad to take the insulin so long as I understood why. First, she was appalled that I wasn't taking insulin (apparently she forgot to write that down in my chart 2 weeks ago when I told her), and second, she couldn't answer any of my questions except to say that she had no idea I wasn't on insulin. Finally, she released the biggest, most frustrated sigh I've heard since I last learned we were out of cottage cheese and said, "Well, I guess I'll have to pull your chart and discuss your questions with the doctor because I don't know the answers."
Um...thank you? For doing your job?

Nearly 3pm by that point, I had a sinking sensation I wasn't going to get an answer anytime soon. I sat, completely terrified that I was missing a precious day of insulin that could be saving my baby just because I was raising a stink about why I should take it. Am I completely selfish? Am I one of those patients that assumes to know more than the doctor? Are my instincts clouded by pregnancy hormones?


1 comment:

  1. i'm proud of you for sticking to your guns!!!!! good for you for questioning and standing up for you and Abe!!! so glad that Doula Shmoula is there to support and empower you!!! there's no reason for the "just because" attitude that many Western doctors have...
    you should read Birth Stories by Jane Dwinell - empowering stories of natural birth with individual stories about just about anything that could happen - one whole chapter on Gestational Diabetes...thought of you!!! you are so strong and such a good Mom already!!! :)